The Regional Respiratory Teaching programme is run jointly with the North-West Deanery, and is co-ordinated by Dr James Greenwood (Mersey) and Dr Rowland Bright-Thomas (NW).

The aim is to provide 8-10 high quality away days per year on a range of respiratory topics. The programme runs on a 3-year cycle and aims to cover all major areas of the respiratory curriculum in that time. Teaching day venues vary, but often take place in specialist centres to utilise the expertise available.

Teaching days are not arranged for June and December, with the expectation that trainees will attend the British Thoracic Society Summer and Winter meetings.

Attendance at 70% of the training days is expected, and is reported to Programme Directors to form part of the ARCP process. It is the trainee’s responsibility to ensure that adequate notice is given locally to cover clinical commitments on the teaching days.

Attendance records and feedback are collected electronically by means of SurveyMonkey. Links for each teaching day are widely circulated prior to and at each event.

Respiratory medicine is the specialty which deals with diseases and disorders of the lungs, pleura, pulmonary vasculature and ventilation. These may occur as part of a systemic disease or are localised to the thorax. The range of conditions is very varied and includes asthma and COPD, lung cancer, infections (e.g. pneumonia & tuberculosis), bronchiectasis, pulmonary fibrosis, transplantation, cystic fibrosis, sleep and ventilatory disorders, occupational respiratory disease and pulmonary embolism.

Physicians look after in and outpatients usually with general medical as well as specialty patients. In recent years a number have moved into primary care settings to concentrate on care of long term respiratory conditions. Physicians are skilled at the interpretation of lung function tests, flexible bronchoscopy, pleural procedures and thoracic radiology interpretation.

Respiratory physicians work as part of a multidisciplinary team with specialist nurses, physiotherapists and clinical physiologists. They also have close working relationships with radiologists, pathologists, thoracic surgeons, critical care physicians, oncologists and palliative care physicians.

Respiratory medicine has a strong academic base in the North West. The academic respiratory unit at University Hospital South Manchester (UHSM) is designated as a National Institute of Health Research Clinical Research Facility. There are research opportunities in many different areas for example; asthma, allergy, cough, lung cancer, cystic fibrosis, ILD. Research is varied ranging across clinical, laboratory based or epidemiological projects. Trainees are encouraged to develop a research interest and by the time they gain their CCST/CCT many will have a higher academic qualification (MD or PhD).There is currently one academic fellowship post in respiratory medicine and a number of trainees have been successful in gaining academic clinical lectureship posts.

The range of work is very varied and interesting. Most physicians will be involved in acute general medical on call and have a responsibility for the care of these patients. They will also have specialist patients who may be admitted on take, be referred to clinic by general practitioners or by other hospital doctors.

Many physicians will have developed a subspecialty interest and may run a sub specialist service. Clinical commitments will usually be split fairly evenly between in and out patient work. Patients vary with their problems from acute self-limiting illness, rapidly or slowly progressive terminal disease to chronic disease processes requiring long term care. Skills are required in the care of critically ill patients in critical care settings and at the other extreme terminally ill patients requiring palliative care. There are also increasing opportunities to work across primary and secondary care, for example in the organisation of COPD services.

Teaching of undergraduates is an increasingly important and enjoyable part of the job. There are many opportunities for research and audit.

There has been an expansion in the number of consultant posts in the country (including the North West Region) over the last 10 years. To date none of the North West trainees have encountered any difficulties in obtaining consultant positions, not just in the North West but also in other regions in a mixture of District General and Teaching Hospitals. A few trainees have taken up Consultant posts in Acute and Respiratory medicine.

Would a career in respiratory medicine suit me?

The respiratory physician is one part of a multidisciplinary team and therefore has to be a good team player, as well as on some occasions a leader and strategist. The work can be busy and requires a degree of flexibility.

Good communications skills are essential to interact with colleagues, patients and relatives. Empathy and sensitivity are essential as patients may have life threatening conditions. Attention to detail and good diagnostic skills are an important part of being a good physician. Although the specialty can be hard work it is often very rewarding.

What does the training involve?

There is a national person specification available on the jrcptb web site for entry into higher medical training in respiratory medicine. Trainees will usually have completed 2 years of core medical training, have attained the relevant competencies and will have passed their ARCPs. This will usually be achieved during a rotation through a range of medical specialities. Experience during this time in respiratory medicine and critical care is desirable.

They will also need to be Members of the Royal College of Physicians (MRCP UK or I) by the time they commence the ST3 year, so trainees should have MRCP PACES or have a date to sit it prior to entry into the ST3 year. Audit is an essential part of training. Research experience, a case report or an audit on a respiratory topic will undoubtedly give you more to talk about at interview.

Specialist training in the North West is aimed at achieving dual accreditation in respiratory and general internal medicine (acute). The usual training programme lasts for 5 years (ST3-ST7), in posts providing a mixture of general and specialist experience. Entrance into the ST3 position is via the national selection process (www.st3recruitment.org.uk). Trainees may take periods out of programme (OOP) training to pursue research projects. OOP training must be applied for at least 6 months in advance and adhere to the deanery guidelines with clear objectives provided. To avoid gaps in the rotation there is a limit to the number of trainees allowed OOP at the same time. There is currently one academic fellowship post in respiratory medicine appointed to every year at CT1-ST3 level for a duration of 3 years and a number of trainees have been successful in gaining academic clinical lectureship posts. The SCE (Specialist Certificate Examination) is a mandatory examination for Respiratory trainees. It is recommended you sit the examination in your penultimate year of training i.e. ST6 or above.

There are at present 37 Trainee posts in the North West Region. The trainees rotate between the regional centre (UHSM), inner city ‘teaching hospitals’ (Manchester Royal Infirmary, Salford Royal, North Manchester General) and a selection of teaching and district general hospitals (Stockport, Bolton, Preston, Bury, Oldham, East Lancashire, Blackpool, Barrow, Wigan, Tameside, Lancaster). The rotations occur every 12 months and trainees will have three DGH, one teaching hospital and one regional centre slot. LAT (locum appointment to training posts) were phased out in 2016. Trusts will appoint locally to locum appointment for service (LAS) posts which provide good experience to help with NTN applications. The TPD (Training programme director) is happy to be contacted directly about availability of these posts.

This programme provides training in all aspects of respiratory medicine and continued experience in general internal medicine. There are opportunities for trainees to develop specialist interest or expertise e.g. cystic fibrosis, transplantation, occupational respiratory disease, asthma and allergy, pleural procedures, critical care and interventional bronchoscopy.

Research is encouraged throughout the training programme. There are extensive facilities to support research at the North West lung Centre (UHSM).

Teaching is also encouraged and all trainees get the opportunity to complete module 1 of a PG Certificate in Medical education at Edge Hill University in ST4.

Leadership is recognised as an important attribute and all senior trainees have an opportunity to complete the Medical leadership In Practice module run by Edge Hill.

There is an education programme for respiratory medicine, which runs jointly with the Mersey Deanery providing 10 training days a year. It includes an induction day with practical skills training. In addition there is a General/Acute internal medicine education programme which runs for 5 days a year. Trainees are encouraged to attend specialist training courses run by the British Thoracic Society and are also expected to attend National and International (at least 1 during the training programme) meetings. The chair of the STSC controls a budget for study leave.

The trainees are required to keep a training record. The specialist training committee assesses the progress of trainees annually using the ARCP process.